By selecting this checkbox and clicking Submit, you are requesting our help and confirming that you and/or the referral have permission to share this information. There is no cost for this service. Our team may contact you by phone, text, or email within 48 hours to explain benefits and guide the next steps. Message and data rates may apply.

Your information will remain confidential and used only to support the workers’ compensation claim process, in compliance with applicable privacy laws. Submitting a referral does not guarantee claim approval or specific benefits. Questions? Call 1-888-534-1969 or email [email protected].